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Heart Valve Services

A mitral valve replaced by a nonsurgical, transcatheter procedure. Image courtesy Medtronic.

The most common heart defects are those of the valves –– the leafleted structures that control blood flow into, within and out of the heart. These valves are meant to open and permit blood to flow freely through them and then close to prevent the blood from returning in the reverse direction.

But valves may be floppy or unpliable. They may be improperly formed and may stiffen as a result of scarring or calcium deposits. In these cases, they may fail to open properly or close completely, hindering blood flow through them or permitting leakage of blood back through them (regurgitation or valve insufficiency). Specialists diagnose heart valve problems in millions of Americans every year, but many go untreated or undertreated, resulting in loss of vitality and additional health risks.

Medications can reduce the severity of valve insufficiency but are not as effective for valves that narrow due to stiffening. Valves that significantly compromise cardiovascular function cause the heart to work harder, with the risk of eventually causing heart failure. Such valves may need to be repaired or replaced, and timely intervention can help prevent the complications they cause. Emphasis is on repairing valves or treating the natural valve so it can continue to function when possible, but often they must be replaced, and today the options for doing so have greatly improved.

Newer valve procedures are significantly improving the quality of patients’ lives,
giving them greater physical capacity and
a healthier long-term cardiovascular prognosis.

For patients who need direct intervention in the structural problem affecting their valves, the Virtua Our Lady of Lourdes team will first assess whether it can offer the treatment via a catheter-based procedure. In some cases, the patient may have had previous valve repair or replacement that has failed. And/or, the patient may even have had open heart surgery for this purpose. The team’s interventional cardiologists can place a new valve within (over top) the old valve so that no removal of a previous valve is necessary. The new valve pushes the old valve aside and starts working immediately.

Mitral Valve Conditions

The mitral valve opens to push oxygenated blood from the heart’s left atrium into the left ventricle for ejection from the heart. In a common condition, the valve slips backward (prolapses) and permits blood to regurgitate from the ventricle back into the atrium. The physical defect in the valve that causes this is usually present from birth but may not be detected until adulthood. Most people never have any symptoms from the condition. Even if they have some chest pain, mitral valve prolapse is usually not considered dangerous.

See physician newsletter on the MitraClip to treat common degenerative prolapse of mitral leaflets.

But if mitral regurgitation becomes more severe, an individual may experience heart palpitations and fatigue. Mitral valve prolapse can stress and weaken the heart, causing heart failure, with symptoms such as shortness of breath with exertion and swelling in the legs and feet. Among treatments that the program offers for this condition are:

  • The MitraClip. This important newer device is exactly what its name suggests: a clip for the mitral valve. Interventional cardiologists can place the clip at the end of a catheter and thread it through the blood vessels in the heart. The clip clamps the leaflets of the mitral valve in a more secure position when they are closed but still permits the valve to open to allow blood to be ejected in the proper direction.

The procedure is for patients with severe degenerative (primary/organic) mitral valve regurgitation caused by a physical defect of the valve, but who are not good candidates for traditional open-heart mitral valve repair because such surgery would pose too great a risk for them. Recovery from the procedure is quick and the benefits usually noticeable right away.

  • Transcatheter mitral valve replacement (TMVR). Using this important advancement in minimally invasive procedures, the team can replace the mitral valve via a catheter.  Virtua Our Lady of Lourdes has helped to lead its medical service area in use of this innovative technique that is sparing more patients open heart surgery.
  • Surgery. For patients who need surgery and are suitable for it, the cardiothoracic team offers the latest options in the hands of experienced surgeons, including minimally invasive “keyhole” surgical mitral valve repair or replacement. See below.

Stretching Valves to Open Them Without Surgery

For valves that are stiffened and need to be stretched open to allow better blood flow, cardiac interventional specialists can sometimes offer a procedure called valvuloplasty (also known as PTBV or percutaneous transluminal balloon valvuloplasty). The procedure is an alternative to transvascular replacement or open heart surgery for treating a hardened, narrowed heart valve (heart valve stenosis).

For mitral, aortic, tricuspid, or pulmonary veins that require such treatments, the cardiology team will pass a catheter with a deflated balloon at its tip through a leg vessel (femoral artery) and up to the right atrium. From there, they can move it to the right ventricle or, via a small puncture, into the left atrium. When the balloon is in the right position within the targeted valve, the specialist inflates it to expand the valve’s leaflets, much in the same way that balloon angioplasty expands coronary arteries. The balloon is then withdrawn. This helps the valve to move better afterwards, leaving it freer to open efficiently.

Aortic Valve Conditions

The aortic valve opens to push oxygenated blood from the heart’s left ventricle into the aorta, the body’s largest artery, which supplies blood to the rest of the circulatory system. For symptomatic disease resulting from narrowing or regurgitation, definitive treatment usually means replacing the valve. For this need, the team at Virtua Our Lady of Lourdes offers two options:

  • Transcatheter aortic valve replacement (TAVR).  Using this important and more-recent minimally invasive procedure, the team can replace the aortic valve via a catheter procedure. Virtua Our Lady of Lourdes has helped to lead its medical service area in use of this innovative technique that is sparing more patients open heart surgery. Learn more.
  • Surgery.  Virtua Our Lady of Lourdes is among a select group of hospitals nationwide with a depth of experience in both traditional open aortic valve replacement (AVR) and minimally invasive aortic valve surgery. See below.

Surgical Options

Minimally invasive surgical aortic valve replacement (miniAVR) and minimally invasive surgical mitral valve repair (miniMVR), like TAVR, are part of an evolution away from certain open-heart operations. Increasingly, isolated valve surgeries do not require a traditional open-chest operation. Minimally invasive surgical procedures, performed through smaller incisions, generally result in a shorter length of stay in the hospital and shorter overall recovery.

Experienced centers such as Virtua Our Lady of Lourdes can offer mitral valve repair even to patients with low pumping ability left in their heart. The surgical approach includes conserving as much of the natural leaflet tissue as possible while maximizing its ability to close and preserving the normal motion and shape of the valve. Access for a miniMVR is via a small incision in the right ribs and then through the left atrium directly over the mitral valve, so that only the mitral valve is exposed. Post-surgical limitations are few, with patients generally able to resume activities after one week. Repair of the mitral valve provides better long-term outcomes than replacements, with survival equivalent to that of individuals who have never had mitral valve disease.

Virtua Our Lady of Lourdes has a depth of experience in using these smaller-incision procedures. The team also offers surgical procedures for patients who experience damaged or leaking artificial valves, and those who need re-operation for valve disease. In addition, these surgeons perform operations for abdominal aortic and thoracic aneurysms.

Learn more about surgical options for valve disease.

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